The Evaluation and Management of Visceral Complications in Radiation Fibrosis Syndrome Part 2

Contemporary cancer treatment involves multi-modal therapeutics, and external beam ionizing radiation is utilized in approximately 50% of cases. Radiotherapy destroys cancer cells both directly via apoptosis and indirectly by disrupting cellular mitosis. Healthy tissues may be inadvertently exposed to radiation in the treatment process, leading to cellular damage and subsequent toxicity. Purpose of Review Provide an overview of intrabdominal and pelvic radiation fibrosis syndrome, focusing on clinical application in the cancer rehabilitation setting. Recent Findings While cancer cells are the primary target of radiation, surrounding normal cells and tissues are also affected. Patient co-morbidity, concomitant use of chemotherapies and immunotherapies for cancer treatment, and radiation dose are the most significant predictors of radiation toxicity based on current research. Dose-dependent tissue injury from radiation develops because of the inflammatory response and resulting ischemia that may progress to fibrosis. Radiotherapy toxicity to organs in the abdomen and pelvis can impact digestive health and fertility and increase the risk of radiation-associated malignancy, primarily in the bladder and distal colon. Summary Given the negative impact on quality of life and mortality in patients with radiation fibrosis syndrome, clinicians should be aware of its predictors, signs, and symptoms to ensure early recognition of radiation toxicity. Herein, we present part 2 of the visceral complications of radiation fibrosis syndrome, addressing radiation-related toxicity in the abdominal and pelvic cavities.